【摘要】 目的　从拉米夫定治疗慢性乙型肝炎停药后复发的病例分析中 ,找寻可汲取的经验教训。方法　共 5 1例病人。 44例擅自停药或误用他药后复发 ,其中 3 7例原为HBeAg阳性 ,4例发生HBeAg血清转换不足 3个月 ,7例原为HBeAg阴性 ,平均用药时间 12个月。另 7例系遵医嘱停药后复发 ,5例原为HBeAg阳性 ,发生HBeAg血清转换后 6个月停药 ,平均用药时间 18个月 ;2例原为HBeAg阴性 ,平均用药时间 3 2个月。结果　所有病人停药时ALT、AST、TBIL正常、HBVDNA降至检测水平以下。两组停药至复发平均时间为 4个月和 6个月。擅自停药或误用他药组复发后病情较重 ,特别是治疗前已有严重肝损害或肝硬化者 ,因肝癌或肝衰竭死亡 3例。遵医嘱停药组复发后临床经过较轻。复发时呈代偿性肝病的 3 5例再次予以拉米夫定治疗 ,其中 13例联合应用干扰素 ,病情恢复顺利 ,但 9例于 12个月后出现YMDD变异。复发时呈失代偿肝病的 10例中 6例再次服用拉米夫定 ,5例病情得以恢复 ,1例恶化死亡。结论　拉米夫定治疗慢性乙型肝炎未达停药标准而停药者 ,极易复发 ,治疗前已有严重肝损害或原有肝硬化者 ,复发后可致肝衰竭 ,即使达到停药标准遵医嘱停药后少数仍有复发。复发者再次服用拉米夫定依然有效 ,但长期服药会增加病毒的耐药变异。因此 ,急?更多还原

【Abstract】 Objective To study the referential experience or lessons by analysis of relapse patients with chronic hepatitis B after stopping lamivudine treatment.Methods This study included 51 patients in total. 44 stopped lamivudine therapy self-assertively or took the fake medicine inadvertenly. 37 of them were HBeAg positive at baseline, 4 patients had seroconversion from HBeAg to anti-HBe within 3 months, and 7 were HBeAg negative at baseline. The mean duration of treatment was 12 months. The other 7 patients withdrew lamivudine on doctor’s advice, among them 5 were HBeAg positive at baseline and maintained lamivudine therapy more than 6 months after HBeAg seroconversion, the mean duration of treatment was 18 months.2 of 7 were HBeAg negative at baseline and the lamivudine therapy persisted for 32 months.Results Normal ALT, AST, TBIL and undetectable HBV DNA were demonstrated in all patients at the time of withdraw lamivudine. In self-stopping treatment group and on doctor’s decision group, the mean duration between lamivudine withdrawal and hepatitis relapse were 4 months and 6 months, respectively. The recurrent status in former group was more severe, especially for those who had been in severe liver injury or liver cirrhosis at baseline. 3 cases in this group died of liver failure or hepatocellular carcinoma. In the latter group, on the contrary, relapsing manifestation appeared to be much milder. 35 patients re-started lamivudine therapy,13 of them were combined with interferon alpha. They recovered favorably, but 9 developed YMDD mutation after 12 months.6 of 10 patients with decompensated liver condition after relapse were retreated with lamivudine alone. 5 cases recovered smoothly and 1 died. Conclusion Patients with chronic hepatitis B are likely to relapse if they stop lamivudine earlier than achieving the withdrawal requirement, especially those who have had severe liver injury or liver cirrhosis before lamivudine treatment may lead to liver failure. A small portion of those who have reached the withdrawal criterion might relapse as well. Lamivudine retreatment is usually effective for relapsing hepatitis, but longterm lamivudine therapy is more likely to develope resistant mutation.更多还原